An increase of pulse pressure by 10 mm Hg was found to increase the risk of a cardiovascular event, stroke, or overall mortality by 10—20 percent. Another study found that an increased pulse pressure was associated with increased mortality among those with severe kidney disease.
However, a retrospective study of people admitted to a hospital for sepsis found that pulse pressure greater than 70 mm Hg was actually associated with a decrease in mortality. High blood pressure readings are still predictive of adverse cardiovascular events as well. For example, consider two people with a pulse pressure measurement of 60 mm Hg.
Despite having the same pulse pressure measurement, the second person is more at risk for an adverse event. Treatment of high blood pressure, if present, can often lead to a reduction in pulse pressure. Nitrates have been shown to reduce both systolic blood pressure and pulse pressure while retaining diastolic blood pressure levels.
Additionally, one study found that dietary supplementation with folic acid led to reduced pulse pressure in men with a normal or slightly elevated systolic blood pressure. This study was performed in healthy younger men ages 20—40 and not in older participants with increased pulse pressure due to age or hypertension. Pulse pressure is calculated by subtracting your diastolic blood pressure measurement from your systolic blood pressure measurement. It tends to increase as you age, and it can be predictive of cardiovascular events such as heart attack or stroke.
Treating high blood pressure can often lead to a reduction in pulse pressure as well. Lifestyle changes can significantly reduce high blood pressure and even lower your risk of hypertension in the future. Learn how garlic and dark…. Foods that are rich in potassium, magnesium, and calcium can help lower blood pressure. Take a look at our list and see which ones you'd like to add….
But what does that mean? Heart disease is the leading cause of death in men and women. You may be taking steps to reduce your risk, but how do you know if you're doing enough? Exercise is key to preventing heart disease. Statistics show a link between exercise and reduced risk of heart disease.
Several factors can affect blood pressure readings, including eating, not eating, and diet. Learn what can affect them and how to take an accurate…. All tests were two-sided. A total of patients were included in the original study. The present analysis was performed on the remaining patients. Mean follow-up was Kaplan—Meier survival analysis demonstrated that overall 1 year mortality was Baseline characteristics of the patient population are presented in Table 1.
There were substantial differences between patients with lower and higher PP Table 1. Mean PP was 47 range 11— mmHg. Survival in each quartile of PP is presented in Figure 1. Survival in the first three quartiles were similar Q1: Multivariable independent predictors of mortality are presented in Table 2. Both lower PP [hazard ratio HR 0. From the patients that were included in The Netherlands, patients agreed to participate in a pre-defined neurohormonal substudy.
This relation remained statistically significant after adjustment for systolic and diastolic blood pressure, glomerular filtration rate, and other possible confounders as described in Table 1 , except for ANP. A low PP is independently associated with increased mortality in this population.
In addition, elevated natriuretic peptides were significantly and independently related to lower PP. There are several explanations for the apparent discrepancy of the predictive value of PP in different populations. PP is mainly determined by stroke volume and arterial compliance. When systolic left ventricular function and stroke volume are normal, an elevated PP is thought to principally reflect decreased aortic elasticity.
The resulting increase in pulsatile load is thought to have an adverse effect on cardiac function and result in an increased risk of clinical events. In addition, arterial compliance is related to atherosclerosis, and a higher PP in patients with a normal cardiac function probably reflects more severe atherosclerosis.
This scenario is thought to apply especially to hypertension and stable coronary heart disease. As a higher PP was related to cardiovascular events in these patients as well, the effects of a decreased aortic elasticity seem to be more important than the effects of a decreased stroke volume. Obviously, the effects of a decreased stroke volume, reflected by a lower PP, become more important than a decreased aortic elasticity.
This is further supported by the finding that the effects of PP were more pronounced in patients with a lower PP, probably reflecting a group of patients without a decreased aortic elasticity. These findings were supported by the results of Shah et al. In a more recent study by Nohria et al. In particular, the separation between patients with higher and lower PP was a post hoc analysis.
The data collected are in a clinical trial setting and we recognize that the findings require verification in prospective epidemiological studies of appropriate populations.
Blood pressure measurement was not performed in a uniform manner. This may be regarded as a criticism, but reflects real-life practice. PP provides a readily available, clinic, or bedside prognostic indicator in advanced CHF. Low PP independently predicts increased mortality. Moreover, low PP is independently related to increased natriuretic peptides.
Pulsatile versus steady component of blood pressure: a cross-sectional analysis and a prospective analysis on cardiovascular mortality. Hypertension ; 13 : — Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham heart study. Circulation ; : — Pulse pressure: a predictor of long-term cardiovascular mortality in a French male population. Hypertension ; 30 : — Measures of blood pressure and myocardial infarction in treated hypertensive patients.
J Hypertens ; 13 : — Increased pulse pressure and risk of heart failure in the elderly. JAMA ; : — Pulse pressure and risk for myocardial infarction and heart failure in the elderly. J Am Coll Cardiol ; 36 : — Association of increased pulse pressure with the development of heart failure in SHEP. Am J Hypertens ; 14 : — Determinants and prognostic information provided by pulse pressure in patients with coronary artery disease undergoing revascularization. Am J Cardiol ; 87 : — Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function.
SAVE investigators. We used multivariable regression analysis to define the determinants of PP and the Cox proportional hazards regression model for survival analysis. We examined whether the baseline data were predictive for the time to death from a cardiovascular CV cause. Survival analyses were also performed with exclusion of these patients. The prognostic value of a variable is given by its hazard ratio HR , which estimates how much the incidence of the event changes when the independent variable increases by a predefined amount or whether it is present or not.
The following variables were considered as possible determinants of CV mortality: VO 2 peak, PP, mean, systolic and diastolic BP, heart rate, age, gender, body mass index, LVEF, CHF aetiology, history of hypertension or diabetes, and serum sodium and creatinine concentration.
Table 1 summarizes the general characteristics of the patients. Median time of follow-up time until death, HTX, or the last available information on vital status was 1. During the total follow-up time of patient-years, 54 patients died from a CV cause sudden death: 26; heart failure: 21; arrhythmias: 6; stroke: 1 , at a median age of Three patients died from a noncardiovascular cause two patients from cancer and one from bronchopulmonary infection.
In multivariable regression analysis, PP was significantly and positively related to mean BP and to left ventricular ejection fraction LVEF and negatively to heart rate. PP was not a significant independent predictor of CV mortality when offered as a continuous variable to the multivariable Cox regression model.
The results were similar when the patients who underwent HTX were excluded from the analyses. Two comments are of interest. In the absence of advanced CHF, a high PP mainly reflects vascular stiffening, which contributes to a worse prognosis, whereas in patients with advanced CHF, LV ejection rate is the main determinant of PP so that a low PP reflects at least partly poor LV function and a worse prognosis.
A number of limitations have to be considered. We used an existing database 9 to assess the prognostic significance of a low PP in patients with advanced CHF, mainly to determine whether PP adds prognostic precision to the generally accepted prognostic value of VO 2 peak. Our findings can therefore not be extrapolated to other patients with CHF.
It is possible that the prognostic value of PP is of particular importance in patients with severe CHF who are unable to exercise.
Measurements of vascular stiffness, such as pulse wave velocity and carotid augmentation index, were not included in the pre-HTX evaluation of our patients, so that we could not include an independent assessment of vascular stiffness in the analyses. Finally, the size of our single-centre study is relatively small and confirmation of our results in larger studies is warranted. Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects.
Hypertension ; 32 : — Is pulse pressure useful in predicting coronary heart disease? The Framingham Heart Study. Circulation ; : — The pulse pressure-to-stroke index ratio predicts cardiovascular events and death in uncomplicated hypertension. J Am Coll Cardiol ; 38 : —
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